title: Component-resolved diagnostics for the evaluation of peanut allergy in a low-prevalence area.
abstract: BACKGROUND
  Major allergenic components of peanut from distinct geographical regions are widely dispersed. Most of the diagnostic studies are from countries with a high prevalence. There have been only few reports of allergen component sensitizations from countries with a low prevalence of peanut allergy. We aimed to investigate roles of component-resolved diagnostic (CRD) to differentiate peanut allergy and peanut tolerance in the Asian population from a country with low prevalence of peanut allergy.
  
  
  METHODS
  Participants with peanut sensitization were enrolled. Clinical reactions were determined. Skin prick test (SPT) and specific IgE (sIgE) to peanut and related allergen components were performed.
  
  
  RESULTS
  Forty subjects with peanut sensitization were included. The mean wheal sizes of SPT and peanut sIgE were not good predictors for differentiating peanut reactions. SIgE to rAra h 2 was more often found in patients with peanut allergy and anaphylaxis. sIgE to rAra h 9 was also more frequent in the peanut-allergic group but not related to severe reactions. In the peanut-tolerant group, despite positive SPT and/or sIgE to peanut, 90% had negative sIgE to rAha h 2 and rAra h 9. Combining rAra h 2 and rAra h 9 resulted in high performance of the test with sensitivity, specificity, positive predictive value, and negative predictive value of 84%, 90%, 0.89, and 0.86, respectively. The ratio between rAra h 2 sIgE to peanut sIgE of 0.6 can be helpful in predicting patients who will develop severe reaction. SIgE to cross-reactive carbohydrate determinants (CCD) was exclusively found in the peanut-tolerant group (33.3% vs. 0%, p = 0.012).
  
  
  CONCLUSIONS
  Our study identifies three allergen components: rAra h 2, rAra h 9, and CCD as important components in the diagnosis of peanut allergy in an Asian country with low prevalence. The ratio between rArah h 2 sIgE to peanut sIgE can be used for predicting patients who will develop anaphylaxis.
authors.affiliation: Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Narissara
authors.initials: N
authors.lastname: Suratannon
authors.forename: Jarungchit
authors.initials: J
authors.lastname: Ngamphaiboon
authors.forename: Jongkonnee
authors.initials: J
authors.lastname: Wongpiyabovorn
authors.forename: Panitchaya
authors.initials: P
authors.lastname: Puripokai
authors.forename: Pantipa
authors.initials: P
authors.lastname: Chatchatee
mesh_terms: D055516:2S Albumins, Plant / Q000276:immunology*; D000707:Anaphylaxis / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D052179:Antigens, Plant / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004040:Dietary Carbohydrates / Q000276:immunology*; D005260:Female; D006023:Glycoproteins / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D021183:Peanut Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D010940:Plant Proteins / Q000276:immunology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012680:Sensitivity and Specificity; D012882:Skin Tests; D013785:Thailand
chemical_list: D055516:2S Albumins, Plant; D052179:Antigens, Plant; C500890:Ara h 2 allergen, Arachis hypogaea; C544631:Ara h 9 allergen, peanut; D004040:Dietary Carbohydrates; D006023:Glycoproteins; D010940:Plant Proteins; D007073:Immunoglobulin E
keywords: Asia; component-resolved diagnostic; peanut allergy